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Saita E, Acquati C, Molgora S, Vagnini D, Piccolo EM, Valenti F, Stratta G, Grassi MM. Locally advanced breast cancer (LABC) and delayed care: a qualitative analysis of psychosocial factors. PSYCHOL HEALTH MED 2023; 28:408-418. [PMID: 35521977 DOI: 10.1080/13548506.2022.2073379] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The literature has extensively documented how delayed access to health care services in the context of cancer can result from subjective characteristics, dysfunctional coping styles, barriers to care, or procrastination. However, limited research has investigated the psychosocial experience of women diagnosed with Locally Advanced Breast Cancer (LABC). This qualitative study aimed at understanding cognitive, emotional and relational factors associated with delayed access to care and treatment decision-making. In-depth interviews with 14 Italian women were conducted. A thematic analysis of elementary contexts using T-LAB was used to identify the association between emerging clusters and participants' coping styles as measured by the Mini-MAC. Five clusters were identified: 'relationships', 'ineluctability', 'disease', 'surgery', and 'diagnosis'. The 'relationships' cluster was characterized by elevated rates of Fighting Spirit (p < 0.01) while Anxious Preoccupation was associated with 'surgery' (p < 0.01). Findings contribute to explain individual and relational variables related to delay seeking care of LABC patients by illustrating the interplay of personal motivations and social networks' characteristics. Evidence from this work expands current understanding of the interplay of factors contributing to delays in seeking medical attention and may be utilized to inform strategies to timely identify women at greater risk.
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Affiliation(s)
- Emanuela Saita
- Department of Psychology, Università Cattolica Del Sacro Cuore, Milan, Italy
| | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, TX, USA.,Department of Clinical Sciences, College of Medicine, University of Houston, Houston, TX, USA.,Department of Health Disparities Research, The UT MD Anderson Cancer Center, Houston, TX, USA
| | - Sara Molgora
- Department of Psychology, Università Cattolica Del Sacro Cuore, Milan, Italy
| | - Denise Vagnini
- Department of Psychology, Università Cattolica Del Sacro Cuore, Milan, Italy
| | | | | | - Gregorio Stratta
- Breast Unit, Humanitas Gavazzeni Clinical Institute, Bergamo, Italy
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Montagna G, Schaffar R, Bordoni A, Spitale A, Terribile DA, Rossi L, Bergeron Y, van der Linden BWA, Konzelmann I, Rohrmann S, Staehelin K, Maspoli-Conconi M, Bulliard JL, Meani F, Pagani O, Rapiti E. Management and Outcome of Young Women (≤40 Years) with Breast Cancer in Switzerland. Cancers (Basel) 2022; 14:cancers14051328. [PMID: 35267635 PMCID: PMC8909610 DOI: 10.3390/cancers14051328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 01/27/2023] Open
Abstract
Background: An increase in breast cancer (BC) incidence in young women (YW) as well as disparities in BC outcomes have been reported in Switzerland. We sought to evaluate treatment and outcome differences among YW with BC (YWBC). Methods: YW diagnosed with stage I-III BC between 2000−2014 were identified through nine cancer registries. Concordance with international guidelines was assessed for 12 items covering clinical/surgical management, combined in a quality-of-care score. We compared score and survival outcome between the two linguistic-geographic regions of Switzerland (Swiss-Latin and Swiss-German) and evaluated the impact of quality-of-care on survival. Results: A total of 2477 women were included. The median age was 37.3 years (IQR 34.0−39.4 years), with 50.3% having stage II BC and 70.3% having estrogen receptor positive tumors. The mean quality-of-care score was higher in the Latin region compared to the German region (86.0% vs. 83.2%, p < 0.0005). Similarly, 5- and 10-year overall survival rates were higher in the Latin compared to the German region (92.3% vs. 90.2%, p = 0.0593, and 84.3% vs. 81.5%, p = 0.0025, respectively). There was no difference in survival according to the score. In the univariate analysis, women in the Latin region had a 28% lower mortality risk compared to women in the German region (hazard ratio 0.72; 95% CI 0.59−0.89). In the multivariable analysis, only stage, differentiation, tumor subtype and treatment period remained independently associated with survival. Conclusions: We identified geographic disparities in the treatment and outcome of YWBC in Switzerland. National guidelines for YWBC should be implemented to standardize treatment. Awareness should be raised among YW and clinicians that BC does not discriminate by age.
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Affiliation(s)
- Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10001, USA;
| | - Robin Schaffar
- Geneva Cancer Registry, University of Geneva, 1205 Geneva, Switzerland;
| | - Andrea Bordoni
- Ticino Cancer Registry, Cantonal Institute of Pathology, 6600 Locarno, Switzerland; (A.B.); (A.S.)
| | - Alessandra Spitale
- Ticino Cancer Registry, Cantonal Institute of Pathology, 6600 Locarno, Switzerland; (A.B.); (A.S.)
| | - Daniela A. Terribile
- Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Multidisciplinary Breast Centre, Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Lorenzo Rossi
- Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland;
- Breast Unit of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (F.M.); (O.P.)
| | - Yvan Bergeron
- Fribourg Cancer Registry, 1705 Fribourg, Switzerland; (Y.B.); (B.W.A.v.d.L.)
| | - Bernadette W. A. van der Linden
- Fribourg Cancer Registry, 1705 Fribourg, Switzerland; (Y.B.); (B.W.A.v.d.L.)
- Population Health Laboratory (#PopHealthLab), University of Fribourg, 1705 Fribourg, Switzerland
| | | | - Sabine Rohrmann
- Cancer Registry Zurich, Zug, Schaffhausen and Schwyz, University Hospital Zurich, 8091 Zurich, Switzerland;
| | | | | | - Jean-Luc Bulliard
- Neuchâtel and Jura Cancer Registry, 2000 Neuchâtel, Switzerland; (M.M.-C.); (J.-L.B.)
- Vaud Cancer Registry, Centre for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland
| | - Francesco Meani
- Breast Unit of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (F.M.); (O.P.)
- Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
| | - Olivia Pagani
- Breast Unit of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland; (F.M.); (O.P.)
- Geneva University Hospitals, 1205 Geneva, Switzerland
- Swiss Group for Clinical Cancer Research (SAKK), 6500 Bellinzona, Switzerland
| | - Elisabetta Rapiti
- Geneva Cancer Registry, University of Geneva, 1205 Geneva, Switzerland;
- Correspondence: ; Tel.: +41-22-379-4950
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Kolben T, Beyer S, Ghasemi S, Hermelink K, Meister S, Degenhardt T, Himsl I, Edler von Koch F, Kolben TM, Wuerstlein R, Mahner S, Harbeck N, Hester A. Late Presentation at Primary Diagnosis of Breast Cancer: Patients' Personality Characteristics and Attitudes. Breast Care (Basel) 2021; 16:343-349. [PMID: 34602939 DOI: 10.1159/000509597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Breast cancer (BC) is the most common cancer in women worldwide. Despite screening and information efforts, about 10% of patients present with tumor size T3 or T4 at primary diagnosis. Late presentation is associated with more advanced tumor stage and consecutively with worse survival rates. Objective This study aimed to evaluate whether patients with a late presentation at primary BC diagnosis differ in their personality from those with early diagnosis. Methods In this bicentric, observational study, personality traits, positive and negative affectivity, anxiety, spirituality, illness beliefs, and sociodemographic characteristics were assessed in BC patients who presented with T-stages 3 or 4 (late presenters) and T-stages 1 or 2 (controls) at initial diagnosis. Results Forty patients (20 controls, 20 late presenters) were interviewed. "Late presenters" perceived their disease as long lasting and had significantly more "positive affectivity" in the current trait. Although no significant associations were found, there was a trend for late presenters to have higher education levels, less spiritual longing, less accurate explanation of their illness, less anxiety in the trait scale, and more conscientiousness than the controls. Conclusion As patients with late presentation for BC differ in specific psychological and sociodemographic characteristics from patients with early BC, the findings of this pilot project warrant additional investigations to identify further specific characteristics and motivations. Identifying patients at risk for late presentation and encouraging them to accept an earlier diagnosis could help to improve their therapy and, finally, their outcome.
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Affiliation(s)
- Thomas Kolben
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Susanne Beyer
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Sanaz Ghasemi
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Kerstin Hermelink
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Sarah Meister
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Tom Degenhardt
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Isabelle Himsl
- Department of Obstetrics and Gynecology, Klinikum Dritter Orden, Munich, Germany
| | - Franz Edler von Koch
- Department of Obstetrics and Gynecology, Klinikum Dritter Orden, Munich, Germany
| | - Theresa M Kolben
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Rachel Wuerstlein
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Nadia Harbeck
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Anna Hester
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
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Breast cancer in the oldest old (≥ 89 years): Tumor characteristics, treatment choices, clinical outcomes and literature review. Eur J Surg Oncol 2020; 47:796-803. [PMID: 33097334 DOI: 10.1016/j.ejso.2020.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Risk of breast cancer increases with age and very few data are available in patients older than 89. METHODS A retrospective analysis on patients aged 89 and older treated between 2008 and 2019 at our certified breast center. The aim was to analyze clinical characteristics, decision-making, treatment, outcomes and open questions regarding this subpopulation for which there is a lack of guidelines. RESULTS 58 patients included. Tumor characteristics were analyzed, 85% patients underwent surgery of which 44% had a mastectomy. The median follow-up and overall survival were 20 and 76 months, respectively.The median survival of metastatic and non-metastatic patients were 14 and 50 months, respectively. Most patients did not receive any adjuvant treatment and among these 14% had a relapse. CONCLUSIONS Elderly patients should not be under or over-treated because of their age; they represent a large heterogeneous group deserving a sub-stratification for a better tailored treatment.
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The impact of depression on adherence to organized and opportunistic breast cancer screening. Eur J Cancer Prev 2019; 29:53-59. [PMID: 30998527 DOI: 10.1097/cej.0000000000000520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
One in five women will experience depression over her lifetime, and one out of eight will develop breast cancer. We evaluated the effect of depression on adherence to mammography in Switzerland, where opportunistic and organized screening programs coexist. We analyzed data from 3206 women aged 50-69 who participated in the Swiss Health Survey 2012. We compared mammographic rates among women with no to mild versus moderate to severe depressive symptoms. The effect of the type of screening on the odds of undertaking a mammography was calculated using multivariable logistic regression analysis. Women with moderate to severe major depressive symptoms were more likely to have had a mammography in the previous 2 years than their nondepressed or less-depressed counterparts (51 vs. 39.2%, respectively, P = 0.005). In the multivariable analysis, women with no to mild major depression living in cantons with an organized screening program had an adjusted odds ratio of 2.7 (95% confidence interval: 2.30-3.17, P < 0.001) of having had a mammography within the past 24 months compared with those living in the regions with an opportunistic screening. The adjusted odds ratio for women with moderate to severe major depression was 4.21 (95% confidence interval: 2.13-8.33, P < 0.001). In Switzerland. adherence to mammographic screening among women with moderate to severe major depression is higher than among women with no or minimal major depressive symptoms. This increased adherence is even more pronounced in regions with organized screening.
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